In a recent interview with Fox News host Sean Hannity, 2024 hopeful and former South Carolina Republican Gov. Nikki Haley claimed China’s fentanyl has killed more Americans than the Iraq, Afghanistan, and Vietnam Wars combined.

Verdict: True

An addiction medicine expert confirmed that overdose deaths have exceeded the amount of deaths sustained in all three wars. Data from the Drug Enforcement Agency and Congressional Research Service suggest most fentanyl powder or precursors originate from China.

Fact Check:

Haley claimed China’s fentanyl has killed more Americans than the Iraq, Afghanistan, and Vietnam Wars combined. Haley made these comments in reference to a recent speech delivered by President Joe Biden at the United Nations (UN).

“What did [Biden] talk about? Climate change. He didn’t talk about the fact that China’s buying up our farmland, or stealing, um intellectual property, or putting a spy center off our coast in Cuba. He didn’t talk about a Chinese spy balloon going overhead or the fact that they’ve killed enough Americans with fentanyl than the Iraq, Afghanistan, or Vietnam Wars combined,” Haley said.

The claim appears to be true is true. A total of 4,431 Americans died as a result of Operation Iraqi Freedom, according to September 2023 data from the U.S. Department of Defense (DOD).  74 Americans died as a result of Operation New Dawn, and another 2,354 Americans died as a result of Operation Enduring Freedom in Afghanistan. The data includes both military and civilian casualties, according to the DOD.

Similarly, 58,220 Americans died as a result of the Vietnam War, data from the National Archives show. The number of casualties includes those that are accidents, declared dead, died of wounds, homicide, illness, killed in action, self inflicted, those who are presumed dead with no remains recovered, and those who are presumed dead with remains recovered, though a note beneath the chart detailing the deaths by category indicates the data does not represent official statistics.

Opioids classified under the fentanyl category accounted for 67,325 preventable deaths in 2021, the National Safety Council reported. In comparison, the same class of opioids were responsible for 53,480 deaths in 2020. (RELATED: Were There 110,000 Overdose Deaths In 2022?)

In 2022, 109,680 people died of drug overdoses amid the fentanyl crisis, National Public Radio (NPR) reported, citing numbers from the U.S. Centers for Disease Control and Prevention (CDC). According to the CDC’s website, almost 280,000 people died from overdoses caused by prescription opioids from 1999 to 2021. Additionally, in 2021, almost 71,000 overdose deaths involved the use of synthetic opioids other than methadone.

Furthermore, fentanyl overdose rates quadrupled between 2016 and 2021, according to a CDC report cited in a May 2023 article published by Axios.

Fentanyl is used both intravenously and for pain relief, according to a drug fact sheet from the U.S. Drug Enforcement Agency (DEA). The drug, which is more potent than morphine and heroin, is illicitly produced as a powder or in fake tablets. It can also be sold alone or in combination with other drugs, including heroin, according to the same fact sheet.

Dr. Tildabeth Doscher, an addiction medicine expert at University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences, confirmed that overdose deaths have exceeded the amount of deaths sustained in all three wars.

“It is true that overdose deaths have exceeded deaths from those three wars [Haley] names,” Doscher said. While substance use, overdoses, and fentanyl use are all a “huge problem,” the real problems, Doscher said are “prescribing practices, training practices, overprescribing practices, and a terrible social system.”

Doscher also mentioned that gabapentin, a medicine used to prevent seizures, is now being found in a large portion of opioid deaths. To correct the problem of opioid use, Doscher said more education is needed. In addition, changes need to be made in the primary care setting.

“Substance use disorder is traditionally treated in the realm of behavioral health or the moral failing of a person as an individual instead of the social-political climate we live in. There is a great amount of stigmatization, a lot in the primary care setting, of ‘we don’t treat those people here,’ instead of understanding ‘those people’ are already in treatment practices. Doctors are not being trained to identify the problem. They don’t want to identify the problem because then they say, ‘what do I do?’ My hope is that all primary care settings are at ease for treating all patients with substance use disorders.”

Doscher also cited insurance capitation systems in primary care settings as contributing to the problem of opioid addiction. Primary care settings typically make money from patients’ annual physicals, whereas individuals experiencing opioid addiction need to be seen monthly, she said.

China and Mexico are the primary countries from which fentanyl is brought into the U.S., the DEA said in a 2020 unclassified intelligence report on the drug. According to a figure in the document, most powder forms and precursors to fentanyl originate from China and are shipped directly to the U.S. or bordering countries.

The Congressional Research Service published a report that claims, prior to 2019, China would ship fentanyl directly to the U.S. Recently, however, they have shifted their tactics to work with Mexican drug cartels and other trafficking rings in the country, leading to the recent sanctioning of multiple persons in China and Hong Kong and the addition of China to a list detailing major drug-transit countries, according to the report.

The U.S.-China Economic and Security Review Commission published a report in 2017 suggesting illegal pill presses enabled U.S.-based rings to package between 3,000 to 5,000 pills per hour. In addition, exporters and chemical manufacturers based in China would either mask their identities online via websites or mislabel shipments, making it harder to regulate, according to the report.

Dr. David W. Murray, a senior fellow in drug policy at the Hudson Institute, described the process of how fentanyl enters the U.S. in a phone interview with Check Your Fact.

Murray explained that precursor chemicals used to make the drug come from China, the drug is manufactured in China, and then assembled in Mexico before it is trafficked into the U.S. The fact that fentanyl is a class with many analogs “really throws the game off balance,” Murray said.

Production of the drug is further complicated by the fact that it is often mixed with other drugs such as xylazine (a horse tranquilizer) and nitazene (a painkiller) which are not detected using harm reduction measures such as test strips, leading to more deadly outcomes.

“[The fentanyl crisis] is an escaping wild animal that is giving us a real ride. It’s not slowing down,” Murray said.

Similarly, a U.S. indictment unsealed back in April revealed that the Chinese chemical company Wuhan Shuokang Biological Technology advised Mexico’s Sinaloa cartel about which chemicals could be most effectively combined to make fentanyl in exchange for cryptocurrency payments, the Washington Post reported. The company also reportedly brokered supplies used to make the drug to the cartel, the outlet indicated.

Check Your Fact has contacted the DOD, CDC, and multiple opioid experts for comment. Check Your Fact also contacted the DEA, who declined comment, and directed us to the CDC.